Provider Demographics
NPI:1033516539
Name:GOOD SAMARITAN CARE PROVIDER LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN CARE PROVIDER LLC
Other - Org Name:FOUR SEASONS IN PARADISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:PRAXEDES
Authorized Official - Middle Name:BERNARDO
Authorized Official - Last Name:DEMESA
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:530-877-7676
Mailing Address - Street 1:7419 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3230
Mailing Address - Country:US
Mailing Address - Phone:209-406-6610
Mailing Address - Fax:209-451-4997
Practice Address - Street 1:10740 OAKWILDE AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-9249
Practice Address - Country:US
Practice Address - Phone:209-406-6610
Practice Address - Fax:209-451-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility